Moving the HME Industry Forward

Legislative/Advocacy

AAHomecare Audit Key is Live and Ready to Accept Crucial Data

January 18, 2016

WASHINGTON, DC – AAHomecare’s HME Audit Key went live on Jan 15. All suppliers are welcome to be part of the data-driven campaign to advocate for much-needed improvements to the audit process and see how their company stacks up in terms of audit volume and appeal overturn rates.

Providers can register and begin entering their Fourth Quarter 2015 audit data starting NOW. The data entry period will be open for a few weeks.

Preliminary findings from the initial HME Audit Key test survey from earlier this year (small test pool) indicated that:

• Suppliers Appealed 80% of MAC Prepayment Denials for Respiratory Products, and 92% Were Overturned;
• 55% of ostomy, urological & wound care supply new patients are subject to MAC prepayment audit;
• Data analysis shows similarities between large national and small suppliers, dispelling the myth that large or small suppliers experience more or less audits;
• Over 86% of MAC prepayment audits of power mobility devices were paid upon review

These preliminary findings are intriguing, but AAHomecare wants to see what data from a larger cohort will tell about how HME suppliers are responding to RAC, MAC, and SMRC audits nationwide. 

Register and find more information at HMEAuditKey.org. In addition, a preview of survey questions and presentations showing how to get started and enter data can be found here.

Bipartisan Support Needed for Rural Bidding Relief/Artificial Bid Limit Legislation
WASHINGTON, DC – In recent discussions on moving forward with competitive bidding rural relief legislation this year, key Congressional staffers pointed to the strong Republican support and need to increase the number of Democratic co-sponsors. 

As of last week, 13 of the 76 co-sponsors are from the Democratic side of the aisle. This is an underdeveloped opportunity for the industry, particularly for suppliers who are located in Democratic districts and/or have established relationships with those Members. AAHomecare asks that providers reach out to those offices in particular and request their support of HR 4185.

Additionally, there are 22 current Democratic members of Congress who were co-sponsors of HR 1717 (legislation establishing a more-focused Market Pricing Program approach to Medicare bidding) in the last Congressional session who are not yet co-sponsors of HR 4185. If your legislators are on this list, please contact them and ask that they get on board as co-sponsors.

While HR 4185 provides relief for suppliers in non-bid areas, it also contains a critical provision for all suppliers by lifting the cap on the bid ceiling for future rounds of bidding. Without this important protection, future rounds of bidding would have their bid ceiling at the last contracted bid rate. 

This price-setting mechanism by CMS fails to follow Congress’ intent to find true market-driven prices for home medical equipment and will put artificial downward pressure on future bidding rounds, ultimately leading to government-induced caps that are below costs for suppliers to provide items and services.

If you need any assistance in finding contact information for members of Congress, e-mail Gordon Barnes at gordonb@aahomecare.org.